2 June Regional Techniques Pt3

Question 1

What are the three types of veracity for local anesthetics?

Answer 1

Isotonic, isobaric, hyperbaric

Isotonic solutions have the same concentration as CSF, isobaric solutions have the same density, and hyperbaric solutions are denser and sink.

Question 2

What is the significance of isobaric solutions in anesthesia?

Answer 2

Isobaric solutions remain where administered, suitable for procedures like total knee replacement

Isobaric solutions are preferred in certain surgical scenarios due to their spread characteristics.

Question 3

What happens to hyperbaric solutions when the patient is placed in a supine position?

Answer 3

They settle at the lowest point, potentially causing hypertension and bradycardia

This occurs because hyperbaric solutions are denser and can rise to higher segments if the patient is flat.

Question 4

What should be prepared before using a hyperbaric solution?

Answer 4

Ephedrine or neosynephrine

These medications are important to counteract potential hypotension and bradycardia effects.

Question 5

What is the recommended site for spinal anesthesia administration?

Answer 5

L4-L5

This is considered the safest site as the spinal cord typically ends at L1-L2 in adults.

Question 6

What is the typical onset time for spinal anesthesia?

Answer 6

4 to 8 minutes

The local anesthetic begins to take effect quickly after administration.

Question 7

What is the purpose of using incremental dosing in epidural anesthesia?

Answer 7

To avoid damaging blood vessels in the epidural space

Incremental dosing helps ensure that the catheter remains in the correct position and does not enter blood vessels.

Question 8

What is the common dosage range of bupivacaine for reaching T10?

Answer 8

10 to 15 milligrams

Dosage can vary based on the specific surgical procedure and patient factors.

Question 9

What is the role of epinephrine in a test dose for epidural anesthesia?

Answer 9

To monitor heart rate changes

Epinephrine helps identify if the catheter is in a blood vessel based on the heart rate response.

Question 10

What is the effect of adding epinephrine to local anesthetics?

Answer 10

Prolongs the duration of anesthesia by 20 to 50%

This is due to epinephrine’s vasoconstrictive properties, which slow the absorption of the anesthetic.

Question 11

What are the potential complications of spinal anesthesia?

Answer 11

Postdural puncture headache, bacterial meningitis, cauda equina syndrome, systemic toxicity

These complications highlight the importance of aseptic technique and careful administration.

Question 12

What is ‘loss of resistance’ in the context of epidural anesthesia?

Answer 12

Technique used to identify the epidural space

This technique is crucial for proper catheter placement in the epidural space.

Question 13

What are the common local anesthetics used for spinal anesthesia?

Answer 13

Bupivacaine, levobupivacaine, chloroprocaine, tetracaine

Each anesthetic has specific properties that make it suitable for various surgical procedures.

Question 14

True or False: There is metabolism of local anesthetics in the cerebrospinal fluid (CSF).

Answer 14

False

Local anesthetics do not metabolize in CSF; reabsorption occurs instead.

Question 15

What is the highest point of the spinal cord when the patient is supine?

Answer 15

C3 and L3

Understanding the anatomy is important for predicting the spread of local anesthetic.

Question 16

Fill in the blank: The concentration of lidocaine for spinal anesthesia is typically _______.

Answer 16

2%

This concentration is commonly used for various surgical procedures requiring spinal anesthesia.

Question 17

What is the purpose of aspirating during an injection?

Answer 17

To ensure there’s no blood coming out, confirming that the needle is not in a blood vessel.

This is crucial for preventing complications during procedures like epidurals or spinal injections.

Question 18

What is a test dose in the context of anesthesia?

Answer 18

A dose that includes epinephrine to monitor changes in heart rate and patient response.

Epinephrine can cause an increase in heart rate, indicating potential complications.

Question 19

What heart rate change might indicate a complication during an injection?

Answer 19

An increase from 100 to 150 beats per minute.

Patients may also report feelings of impending doom.

Question 20

What monitoring is required when performing an epidural or spinal anesthesia?

Answer 20

Monitors must be on, including a pulse oximeter.

EKG monitoring is not always necessary in the operating room.

Question 21

What is the physiological pH that local anesthetics aim to be close to for better efficacy?

Answer 21

7.4

Local anesthetics with a pH closer to 7.4 work faster.

Question 22

Which local anesthetic is known for its rapid onset and is popular in outpatient settings?

Answer 22

Chloroprocaine

Chloroprocaine is often used in OB anesthesia and for procedures where quick recovery is needed.

Question 23

What is the typical dosage range for epidural anesthesia per segment?

Answer 23

1 to 2 cc per segment.

The total dose can range from 6 cc to 12 cc depending on the number of segments treated.

Question 24

What is the main reason for using sodium bicarbonate with local anesthetics?

Answer 24

To increase the speed of onset by making the solution more basic.

This enhances the non-ionized free base content that penetrates cell membranes.

Question 25

True or False: Opioids extend the duration of local anesthesia.

Answer 25

False ## Footnote Opioids enhance the quality of pain management but do not prolong the effect of local anesthetics.

Question 26

What is the lowest and highest dose range for topping off an epidural after regression?

Answer 26

Lowest: 3 cc, Highest: 6 cc ## Footnote This is based on 50% of the initial dose.

Question 27

What are adjunct medications used for in epidural anesthesia?

Answer 27

To extend postoperative analgesia and improve block density. ## Footnote Adjuncts can include opioids and alpha-2 agonists.

Question 28

What complications could arise from using Precedex intrathecally?

Answer 28

Potential neuro complications. ## Footnote While studies show no significant issues, it is not FDA approved for this use.

Question 29

What is the typical concentration of chloroprocaine used for surgical procedures?

Answer 29

3% ## Footnote This concentration is preferred for its fast onset in surgical settings.

Question 30

What is the recommended volume of local anesthetic to use for lumbar epidurals compared to thoracic?

Answer 30

Lumbar epidural space is larger, requiring a bit more volume compared to thoracic. ## Footnote This affects how much anesthetic needs to be administered.

Question 31

Fill in the blank: The initial dose for spinal anesthesia is typically _______.

Answer 31

10 to 15 milligrams. ## Footnote This dosage can vary based on the specific anesthetic used.

Question 32

What is the significance of knowing the type of blade used by the person you are working with?

Answer 32

It helps establish compatibility and comfort in the operating room. ## Footnote Different blades (Miller vs. Mac) can affect technique and communication.

Question 33

What are the two types of opioids discussed?

Answer 33

Hydrophilic and lipophilic

Question 34

Which hydrophilic opioids are mentioned?

Answer 34

* Morphine * Hydromorphone * Demerol

Question 35

What is a common vasopressor used in the ICU?

Answer 35

Epinephrine

Question 36

What is the purpose of a test dose in epidural anesthesia?

Answer 36

To determine if the catheter is in the correct location

Question 37

Fill in the blank: The effect of hydrophilic opioids can last up to _______ hours post-surgery.

Answer 37

24

Question 38

What is a significant risk associated with hydrophilic opioids?

Answer 38

Late respiratory depression

Question 39

What is the typical dosing range for epidural administration of opioids?

Answer 39

* 25 to 50 micrograms * 10 to 20 micrograms per hour for infusion

Question 40

True or False: Lipophilic opioids provide quick pain relief and have a longer duration of action.

Answer 40

False

Question 41

What is the recommended action if a patient experiences itching due to opioids?

Answer 41

Administer Benadryl or other antihistamines

Question 42

What is the common issue with opioid administration in terms of side effects?

Answer 42

* Nausea * Urinary retention

Question 43

What should recovery nurses be informed about when a patient receives hydrophilic opioids?

Answer 43

Respiratory depression can occur later, within 6 to 24 hours

Question 44

What should be done for patients who may be discharged on the same day of surgery?

Answer 44

Perform a bladder scan

Question 45

What is the implication of using opioids as adjuncts to local anesthetics?

Answer 45

Improves pain management without prolonging sensory blockade

Question 46

Fill in the blank: The respiratory depression from lipophilic opioids occurs _______ and tapers quickly.

Answer 46

Early

Question 47

What is the concern with administering Narcan to reverse opioid effects?

Answer 47

It may also reverse pain control

Question 48

What is the significance of preoperative assessment in opioid administration?

Answer 48

To gather information on past complications, especially nausea

Question 49

What is the effect of opioids on urinary retention related to?

Answer 49

Motor blockade affecting the sphincter

Question 50

What should be monitored when a patient is on opioids post-surgery?

Answer 50

Respiratory rate and signs of respiratory depression

Question 51

Fill in the blank: The universal test dose for epidurals contains _______.

Answer 51

Epinephrine

Question 52

What is a common side effect of opioids that anesthesia providers must manage?

Answer 52

Itching

Question 53

What is the significance of urinary retention in patients receiving opioids?

Answer 53

Patients receiving opioids are likely to experience urinary retention due to the effects of hydrophilic and lipophilic properties of the drugs.

Question 54

What should be done before discharging a patient after anesthesia?

Answer 54

A bladder scan should be performed to assess urinary retention, following hospital policy.

Question 55

What is the role of precedence and chill in anesthesia?

Answer 55

Precedence and chill can intensify both sensory and motor blockade during anesthesia.

Question 56

What is an EPI wash?

Answer 56

An EPI wash refers to rinsing the syringe with epinephrine to enhance the effects of local anesthetics.

Question 57

What is the effect of adding epinephrine to local anesthetics?

Answer 57

Adding epinephrine can prolong the duration of local anesthetics but varies by 20-30%.

Question 58

What is the difference between primary and secondary prophylaxis in relation to aspirin?

Answer 58

Primary prophylaxis prevents the first event, while secondary prophylaxis addresses existing blood clots.

Question 59

How long should aspirin be held before a high-risk procedure?

Answer 59

Aspirin should be held for five half-lives before a high-risk procedure.

Question 60

What are the recommendations for discontinuing Plavix before anesthesia?

Answer 60

Plavix should be discontinued for up to seven days before anesthesia.

Question 61

What is the recommended waiting period for unfractionated heparin before anesthesia?

Answer 61

Unfractionated heparin should be held for 24 hours before anesthesia.

Question 62

What is the normal platelet count needed before performing a block?

Answer 62

The platelet count should be at least 100,000.

Question 63

What is the antidote for Coumadin?

Answer 63

Vitamin K is the antidote for Coumadin.

Question 64

What is the importance of cardiac clearance in anesthesia?

Answer 64

Cardiac clearance is essential for patients undergoing high-risk surgical procedures.

Question 65

What is the recommended waiting time for direct oral anticoagulants (DOACs) before anesthesia?

Answer 65

Direct oral anticoagulants should be held for 72 hours before anesthesia.

Question 66

What is a common complication of spinal anesthesia?

Answer 66

A common complication is a post-dural puncture headache.

Question 67

What symptoms are associated with a post-dural puncture headache?

Answer 67

Symptoms include severe headaches when sitting up, photosensitivity, and nausea.

Question 68

True or False: Post-dural puncture headaches occur immediately after the procedure.

Answer 68

False: They usually occur 2 to 3 days after the procedure.

Question 69

What is the recommended treatment for a post-dural puncture headache?

Answer 69

Caffeine is recommended for its vasoconstrictive properties to help seal the puncture.

Question 70

Fill in the blank: The antidote for heparin is _______.

Answer 70

protamine

Question 71

What is a common position for a pregnant woman experiencing post-spinal headache?

Answer 71

Supine position ## Footnote This position helps alleviate symptoms like nausea and vomiting.

Question 72

What are two risk factors for developing post-spinal headaches?

Answer 72

* Younger age * Female gender * Pregnancy

Question 73

What gauge needle is typically used for a spinal procedure?

Answer 73

Gauge 16 or Gauge 22 ## Footnote Gauge 16 is often used for a larger diameter, while Gauge 22 is stiffer and may be preferred in difficult cases.

Question 74

Why is a pencil-point needle preferred over a cutting needle?

Answer 74

It reduces the risk of post-dural puncture headache ## Footnote Cutting needles can increase the risk of complications.

Question 75

What is the purpose of using air as a loss of resistance during a spinal procedure?

Answer 75

To confirm correct placement of the needle ## Footnote Air provides a clearer indication of entry into the epidural space compared to saline.

Question 76

Fill in the blank: A blood patch involves injecting _______ into the epidural space.

Answer 76

10 to 20 cc of the patient's blood

Question 77

What is the effectiveness rate of a blood patch procedure?

Answer 77

90% effective

Question 78

What is a common symptom a patient may experience during a blood patch procedure?

Answer 78

Severe headache or pain

Question 79

What is one minimally invasive treatment method for spinal headaches mentioned?

Answer 79

Spinal Palatine block ## Footnote Involves inserting a cotton swab soaked in lidocaine into the nasal passage.

Question 80

What complication can arise from improperly inserting a spinal needle?

Answer 80

Nerve injury or paresthesia

Question 81

True or False: It is acceptable to repeat the same technique if the first spinal attempt fails.

Answer 81

False

Question 82

What is the recommended skin preparation to avoid bacterial meningitis during spinal anesthesia?

Answer 82

Combination of chlorhexidine and alcohol

Question 83

What are the landmarks used for spinal anesthesia?

Answer 83

L4-L5 interspace

Question 84

What should be done with beta-dine swab before inserting a spinal needle?

Answer 84

It should be scraped off from the insertion site.

Question 85

What is Cauda Equina Syndrome associated with?

Answer 85

Pain and numbness in the saddle area, bowel and bladder dysfunction

Question 86

What historical practice contributed to the understanding of Cauda Equina Syndrome?

Answer 86

Use of high concentrations of lidocaine during anesthesia procedures.

Question 87

What should you do if a spinal anesthesia is not effective after 10 minutes?

Answer 87

Reassess and consider alternative options

Question 88

What is the primary goal of aseptic technique in spinal anesthesia?

Answer 88

To prevent infection and complications

Question 89

What is the best practice for disposing of used materials during a spinal procedure?

Answer 89

Keep the trash can close for easy disposal.

Question 90

What area does the cauda equina extend from?

Answer 90

From the lumbar region (L1) to the sacral nerve (S5)

Question 91

What is a common cause of pain and numbness in patients related to the cauda equina?

Answer 91

High concentration of lidocaine used in the past

Question 92

What concentration of lidocaine is commonly used now?

Answer 92

2% lidocaine

Question 93

What is the purpose of multipore catheters?

Answer 93

To numb multiple nerves in the area

Question 94

What is a significant complication that can occur with epidural anesthesia?

Answer 94

Hematoma

Question 95

What does 'transient neurological symptoms' mean?

Answer 95

Symptoms that do not last long

Question 96

True or False: Transient neurological symptoms are a major concern for patients.

Answer 96

False

Question 97

What should be done if a catheter tip is not visible upon removal?

Answer 97

Inform the patient immediately

Question 98

What color is the tip of the epidural catheter typically?

Answer 98

Blue

Question 99

Fill in the blank: When pulling out an epidural catheter, it should be done very ______.

Answer 99

slowly

Question 100

What should be done if blood is aspirated from an epidural catheter?

Answer 100

Do not use the catheter

Question 101

What can cause unilateral epidural blockade?

Answer 101

Local anesthetic not diffusing completely to one side

Question 102

How can gravity be utilized in cases of unilateral epidural blockade?

Answer 102

Position the patient on the side that is not numb

Question 103

What is the recommended amount of catheter to leave in the epidural space?

Answer 103

3 to 5 cm

Question 104

What is local anesthesia systemic toxicity?

Answer 104

Accidental injection of local anesthetic into systemic circulation

Question 105

What is a key symptom of local anesthesia systemic toxicity?

Answer 105

Cardiovascular and CNS manifestations

Question 106

What is the first thing that occurs with local anesthesia systemic toxicity?

Answer 106

Injection of the local anesthetic

Question 107

What is the worst-case scenario of local anesthesia systemic toxicity?

Answer 107

Cardiopulmonary arrest

Question 108

What is lipid emulsion used for in relation to local anesthesia systemic toxicity?

Answer 108

To treat cardiovascular collapse

Question 109

What should be done if a patient has blood in the epidural needle but not continuously?

Answer 109

Continue with the procedure

Question 110

What are factors that can cause accidental cannulation?

Answer 110

* Multiple attempts * Patient positioning * Pregnancy

Question 111

What is the significance of using ultrasound in regional anesthesia?

Answer 111

To avoid veins and arteries during needle placement

Question 112

What is a top-up dose in epidural anesthesia?

Answer 112

50% of the original dose to enhance analgesia

Question 113

What should be done if a catheter is coiled in the epidural space?

Answer 113

Use normal saline to open the space wider